Abstract
The intra-abdominal pressure (IAP) is an important indicator of the patient's physiologic status because even a slight increase of IAP can have deleterious effects. The aim of this study was to evaluate in all the new patients admitted to general ICUs, during 4 weeks, the incidence of IAP and the possible associated risk factors. At admission, the APACHE II score, etiologic factors (abdominal surgery, hemoperitoneum, abdominal infection, massive fluid resuscitation, ileus, pneumonia and bacteraemia), predisposing conditions (acidosis, polytransfusion, coagulopathy, sepsis and liver dysfunction) and type of admission were evaluated. The IAP was measured twice every day for 7 days, or less if the patient was ICU-discharged or death occurred. Two hundred and sixty-five patients were enrolled from 13 ICUs: mean age 62.8 ± 17.7 years, body mass index 25.9 ± 17.7 kg/m2, APACHE II 17.8 ± 8.7, IAP 9.7 ± 5.0 mmHg, medical patients 132 (49.8%), surgical patients 71 (26.8%), emergency patients 42 (15.8%), trauma patients 20 (7.6%); 62 patients died in the ICU (23.4%). Intra-abdominal hypertension (IAH) was classified as a mean IAP of 12 mmHg or more at admission. There were 80 (30.2%) patients with IAH and 185 (69.8%) without IAH. The only independent risk factors present at admission significantly related to IAH were the number of organ failures (odds ratio [OR] = 1.5, confidence interval [CI] = 1.1-2.0), the abdominal surgery (OR = 2.6, CI = 1.4-5.1), ileus (OR = 2.6, CI = 1.4-4.7) and liver dysfunction (OR = 3.2, CI = 1.6-6.5). These data suggest that either an abdominal problem or the number of organ failures are associated with the IAH.
Highlights
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today
Summary Our study demonstrated that LS is a good alternative to restore cardiac contractile function when combined with NE
The use of AVP may lead to further deteriorate sepsis-related myocardial dysfunction even when combined with a positive inotropic agent
Summary
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today. The objectives of the current study were (1) to assess the prognostic significance of plasma concentrations of NSE for early prediction of outcome in patients at risk for anoxic encephalopathy after cardiopulmonary resuscitation (CPR), and (2) to compare the prognostic information provided by NSE measurements with that provided by conventional risk indicators (clinical neurological examination and computerised tomography [CT] scan of the brain). Independent pulmonary ventilation was introduced in the 1930s and allows the utilization of different ventilatory strategies for each lung to improve gas exchange, respiratory mechanics or both in patients with heterogeneous lung diseases It is not clear whether the lower inflection point (LIP) on the inspiratory limb or the point of maximum curvature (PMC) on the deflation limb of the pressure–volume (PV) curve should be used for the positive end-expiratory pressure (PEEP) setting in acute lung injury (ALI). The long-term outcome, health-related quality of life (HRQL), and ICU and hospital costs of medical ICU patients were assessed
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